Clinical Practice and Cases in Emergency Medicine

Introduction: ST-elevation myocardial infarctions (STEMI) represent complete occlusion of a coronary artery. An electrocardiogram (ECG) is a method of diagnosis; however, on rare occasions clues of myocardial infarction are first noted on imaging. This is a case of myocardial infarction first noted on computed tomography (CT).

Case Report: A 62-year-old man was brought to the emergency department after being found unresponsive with multiple burns. An ECG performed on arrival did not show changes consistent with myocardial ischemia. Due to reported trauma, a CT incidentally found a heterogeneous low-attenuation area in the posterior wall of the left ventricle of the heart. A repeat ECG subsequently showed an inferior STEMI. 

Conclusion: Computed tomography of the chest obtained in the evaluation of trauma may demonstrate evidence of myocardial ischemia. This case highlights the ability of CT to detect cardiac hypoperfusion. The role of CT in myocardial infarction diagnosis remains limited; however, given that the timing of contrast injection depends on the clinical question, it may not reliably assess the hypoperfusion.